We Care What You Think

Misericordia Health Centre welcomes feedback from patients, residents, clients and their families as well as visitors and staff about quality of care and service delivery.

We invite you to use the “We Care What You Think” form below or the printable version to share your recommendations and comments with us. Forms and deposit boxes are also located in prominent places throughout the organization.

The information you provide is confidential. It will help us to track and resolve client and family complaints that arise in the context of care and service delivery. Tracking complaints is an important tool in the continuous improvement of care and services.

Positive feedback is equally useful in planning for the future and in providing recognition and support for the work we do.

* indicates a required field

Date of Visit:*

Date Format: YYYY dash MM dash DD

Time:*

:HH

MM

Department / Program / Unit Involved:*

Overall, how would you rate the care / service received?*

What went especially well with the care you received?*

If you could recommend one improvement, what would it be?*

Did you feel respected by our staff?*

Yes

No

Please explain:*

Additional Comments?

Who completed this form?*

Please specify:*

Thank you for taking the time to provide us with feedback.

Do you wish to discuss your recommendations / comments?*

Yes

No

Your Contact Information

Name:

Telephone:

Email:

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